| NPI | 1851028971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 123226) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2022046613) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2024-09-16 |